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Intestinal ulcers as an initial finding in EBV-associated lymphoproliferative disorder: A case report
Sizhu Wang1, Yinghuan Dai2, Jie Zhang1
1Department of Gastroenterology.
Medicine
|February 4, 2020
Summary
Epstein-Barr virus (EBV)-associated T-cell lymphoproliferative disorder (LPD) can mimic Crohn disease in adults presenting with intestinal ulcers. Early and accurate diagnosis of EBV-LPD is crucial for appropriate management.
Area of Science:
- Gastroenterology
- Oncology
- Infectious Diseases
Background:
- Epstein-Barr virus (EBV)-associated T-cell lymphoproliferative disorder (LPD) is uncommon in adults and rarely presents with gastrointestinal manifestations.
- Intestinal ulcers due to EBV-LPD pose diagnostic challenges due to atypical clinical and pathological presentations.
Observation:
- A 26-year-old male presented with chronic diarrhea and abdominal pain, initially diagnosed as Crohn disease based on colonoscopy and pathology.
- Despite Infliximab treatment for presumed Crohn disease, the patient developed fever and hematochezia, with subsequent identification of EBV-associated T-cell proliferation disease.
Findings:
- Initial biopsies of intestinal ulcers were inconclusive for EBV-LPD, requiring re-examination and immunohistochemical analysis.
- Nasopharyngeal biopsies confirmed EBV-associated T-cell proliferation disease, highlighting the importance of thorough investigation in atypical cases.
Implications:
- EBV-associated T-cell LPD should be considered in the differential diagnosis of adult patients with unexplained intestinal ulcers, even when initial findings suggest common conditions like Crohn disease.
- Diagnostic tools such as repeated biopsies, gene rearrangement studies, EBV DNA quantification, and EBV-encoded RNA (EBER) in situ hybridization are valuable for diagnosing EBV-LPD.
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